肝硬化腹水的诊治
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摘要
腹水是肝硬化失代偿期主要并发症之一。腹水的形成往往提示预后不良,发生自发性细菌性腹膜炎(SBP)、肝肾综合征(HRS)等并发症的概率大大增高。规范化处理肝硬化腹水及其并发症可提高患者的生存质量和生存率。本文结合近期肝硬化相关指南对腹水诊治进行概述。
Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis.Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis and progressive renal impairment.Adequate management of cirrhotic ascites and its complications improves quality of life and increases survival.This article summarizes the advances in diagnosis and therapy of ascites in combination with guidelines.
Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis.Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis and progressive renal impairment.Adequate management of cirrhotic ascites and its complications improves quality of life and increases survival.This article summarizes the advances in diagnosis and therapy of ascites in combination with guidelines.
引文
[1]中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].中华实验和临床感染病杂志:电子版,2017,11(5):417-432.
[2] Gines P,Quintero E,Arroyo V,et al.Compensated cirrhosis:natural history and prognostic factors[J].Hepatology,1987,7(1):122-128.
[3] Planas R,Montoliu S,BallestéB,et al.Natural history of patients hospitalized for management of cirrhotic ascites[J].Clin Gastroenterol Hepatol,2006,4(11):1385-1314.
[4] Krag A,Bendtsen F,Henriksen JH,et al.Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites[J].Gut,2010,59(1):105-110.
[5] Rimola A, Garcíatsao G, Navasa M,et al.Diagnosis,treatment and prophylaxis of spontaneous bacterial peritonitis:a consensus document.International Ascites Club[J].J Hepatol,2001,32(1):142-153.
[6] Runyon BA,Montano AA,Akriviadis EA,et al.The serumascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites[J].Ann Intern Med,1992,117(3):215-20.
[7] European Association for the Study of the Liver.Electronic address:easloffice@easloffice.eu;?European Association for the Study of the?Liver.EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J].J Hepatol,2018,69(2):406-460.
[8] Schrier RW,Arroyo V,Bernardi M,et al.Peripheral arterial vasodilation hypothesis:aproposal for the initiation of renal sodium and water retention in cirrhosis[J].Hepatology,2010,8(5):1151-1157.
[9] Santos J,Planas R,Pardo A,et al.Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis.A randomized comparative study of efficacy and safety[J].J Hepatol,2003,39(2):187-192.
[10] Angeli P,Fasolato S, Mazza E,et al.Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis:results of an open randomised clinical trial[J].Gut,2010,59(1):98-104.
[11] Assy N,Kayal M,Mejirisky Y,et al.The changes in renal function after a single dose of intravenous furosemide in patients with compensated liver cirrhosis[J]. BMC Gastroenterol,2006,6:39.
[12] Mller S,Hansen EF,Becker U,et al.Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients[J].Liver Int,2010,20(1):51-59.
[13] Krag A,Mller S,Henriksen JH,et al.Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome[J].Hepatology,2007,46(6):1863-1871.
[14] Alessandria C,Elia C,Mezzabotta L,et al.Prevention of paracentesis-induced circulatory dysfunction in cirrhosis:standard vs half albumin doses.A prospective,randomized,unblinded pilot study[J].Dig Liver Dis,2011,43(11):881-886.
[15] Saab S,Nieto JM,Lewis SK,et al.TIPS versus paracentesis for cirrhotic patients with refractory ascites[J].Cochrane Database Syst Rev,2006,(4):CD004889.
[16] Chen RP,Zhu GX,Huang ZM,et al.Prophylactic use of transjugular intrahepatic portosystemic shunt aids in the treatment of refractory ascites:metaregression and trial sequential meta-analysis[J].J Clin Gastroenterol,2014,48(3):290-299.
[17] Runyon BA,AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J].Hepatology,2013,29(9):1651-1653.
[18] Boyer TD,Sanyal AJ, Wong F,et al.Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1[J].Gastroenterology,2016,150(7):1579-1589.
[19] Thévenot T,Briot C,MacéV,et al.The periscreen strip is highly efficient for the exclusion of spontaneous bacterial peritonitis in cirrhotic outpatients[J].Am J Gastroenterol,2016,111(10):1402.
[20] Wiest R, Krag A, Gerbes A.Spontaneous bacterial peritonitis:recent guidelines and beyond[J].Gut,2012,61(2):297-310.
[21]杨娟,辛克北,王彦戈.肝硬化并自发性细菌性腹膜炎腹水感染的细菌分布及耐药性分析[J].中国现代药物应用,2016,10(7):142-143.
[22]王凯.肝硬化并自发性细菌性腹膜炎腹水感染的细菌水布及耐药性分析[J].中国现代药物应用,2015,9(18):177-178.
[23] Angeli P, Ginès P, Wong FF, et al.Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites[J].J Hepatol,2015,62(4):968-974.
[2] Gines P,Quintero E,Arroyo V,et al.Compensated cirrhosis:natural history and prognostic factors[J].Hepatology,1987,7(1):122-128.
[3] Planas R,Montoliu S,BallestéB,et al.Natural history of patients hospitalized for management of cirrhotic ascites[J].Clin Gastroenterol Hepatol,2006,4(11):1385-1314.
[4] Krag A,Bendtsen F,Henriksen JH,et al.Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites[J].Gut,2010,59(1):105-110.
[5] Rimola A, Garcíatsao G, Navasa M,et al.Diagnosis,treatment and prophylaxis of spontaneous bacterial peritonitis:a consensus document.International Ascites Club[J].J Hepatol,2001,32(1):142-153.
[6] Runyon BA,Montano AA,Akriviadis EA,et al.The serumascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites[J].Ann Intern Med,1992,117(3):215-20.
[7] European Association for the Study of the Liver.Electronic address:easloffice@easloffice.eu;?European Association for the Study of the?Liver.EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J].J Hepatol,2018,69(2):406-460.
[8] Schrier RW,Arroyo V,Bernardi M,et al.Peripheral arterial vasodilation hypothesis:aproposal for the initiation of renal sodium and water retention in cirrhosis[J].Hepatology,2010,8(5):1151-1157.
[9] Santos J,Planas R,Pardo A,et al.Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis.A randomized comparative study of efficacy and safety[J].J Hepatol,2003,39(2):187-192.
[10] Angeli P,Fasolato S, Mazza E,et al.Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis:results of an open randomised clinical trial[J].Gut,2010,59(1):98-104.
[11] Assy N,Kayal M,Mejirisky Y,et al.The changes in renal function after a single dose of intravenous furosemide in patients with compensated liver cirrhosis[J]. BMC Gastroenterol,2006,6:39.
[12] Mller S,Hansen EF,Becker U,et al.Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients[J].Liver Int,2010,20(1):51-59.
[13] Krag A,Mller S,Henriksen JH,et al.Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome[J].Hepatology,2007,46(6):1863-1871.
[14] Alessandria C,Elia C,Mezzabotta L,et al.Prevention of paracentesis-induced circulatory dysfunction in cirrhosis:standard vs half albumin doses.A prospective,randomized,unblinded pilot study[J].Dig Liver Dis,2011,43(11):881-886.
[15] Saab S,Nieto JM,Lewis SK,et al.TIPS versus paracentesis for cirrhotic patients with refractory ascites[J].Cochrane Database Syst Rev,2006,(4):CD004889.
[16] Chen RP,Zhu GX,Huang ZM,et al.Prophylactic use of transjugular intrahepatic portosystemic shunt aids in the treatment of refractory ascites:metaregression and trial sequential meta-analysis[J].J Clin Gastroenterol,2014,48(3):290-299.
[17] Runyon BA,AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J].Hepatology,2013,29(9):1651-1653.
[18] Boyer TD,Sanyal AJ, Wong F,et al.Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1[J].Gastroenterology,2016,150(7):1579-1589.
[19] Thévenot T,Briot C,MacéV,et al.The periscreen strip is highly efficient for the exclusion of spontaneous bacterial peritonitis in cirrhotic outpatients[J].Am J Gastroenterol,2016,111(10):1402.
[20] Wiest R, Krag A, Gerbes A.Spontaneous bacterial peritonitis:recent guidelines and beyond[J].Gut,2012,61(2):297-310.
[21]杨娟,辛克北,王彦戈.肝硬化并自发性细菌性腹膜炎腹水感染的细菌分布及耐药性分析[J].中国现代药物应用,2016,10(7):142-143.
[22]王凯.肝硬化并自发性细菌性腹膜炎腹水感染的细菌水布及耐药性分析[J].中国现代药物应用,2015,9(18):177-178.
[23] Angeli P, Ginès P, Wong FF, et al.Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites[J].J Hepatol,2015,62(4):968-974.